A sarcastic veterinary blog dedicated to all of the money grubbing vets out there who are fed up with the insanity of the American public.

Friday, September 21, 2012

Speaking of Veterinary Economics....

I read this today http://www.abcmontana.com/news/local/Budget-Would-Fund--170275226.html.
Apparently the state of Montana is considering starting a new vet
program. This press release quotes Montana State University College of Agriculture Dean Jeff Jacobsen as saying, "There is a workforce shortage of veterinarians practicing large animal in Montana."

Yeah? Why is that?

It's not a lack of veterinarians!

There are enough veterinarians willing to practice in rural areas.

Maybe if I say it again:

There are enough veterinarians willing to practice in rural areas.

Maybe if I type it real slow:

T h e r e a r e e n o u g h v e t s . . .

Maybe if an expert says it. A bunch of them, actually.

The American Association of Bovine Practitioners (AABP) (national professional organization for cow vets) made this statement in May 2011:

" there
is not currently a shortage of veterinarians for rural food supply
veterinary private practice....Efforts to increase interest in rural
practice among graduating veterinary students have been successful, so lack of available veterinarians is no longer an issue... there
remain underserved rural areas across the country that may not be
able to sustain a veterinary practice... The committee is extremely
concerned that the perception by veterinary schools and the public that
there continues to be a shortage of rural practitioners is leading to
increased class sizes at veterinary schools and the creation of new
veterinary schools. Continuing to increase the number of veterinarians interested in serving rural areas will not solve this problem."

Figures the guys who remove testicles for a living
would have enough to come out and say that. I'm not hearing it anywhere
else.

I mean, really- the people who make a
living doing it are saying, basically, there's not enough money in some
places to make a living doing it.

So what the hell kind of sense does make to to crank out ten more
heavily indebted* new grads every year to do it in those very
places?!?!!?

Especially since there's not much proof that a state's students will come back to that state to practice.

Much less farm kids.

I married a guy who grew up on a farm. He'll tell you, there's a reason
he went to college. It wasn't so he could go back to the farm and pull
calves in the 20 below dead of night. Very few people are going to put
themselves six figures in debt for that. And they're damn sure not
going to put themselves six figures in debt to do it for chicken feed.

Will
educating kids from Montana mean those kids will come back to Montana
to practice large animal? Especially if there's not enough money for
them to get paid for it?

Must be nice, spending other peoples' money.

Seriously, if I were a Montana taxpayer I
would reeeeeallllyy want to see some independent financials on this.
Would the state not be better off taking the money that's going to go
into this program and paying vets to provide services in those areas, or
hire techs or some sort of paraprofessional to work with existing
remote vets, or set up telemedicine, or, well, ANYTHING a little more
certain to achieve the goal of filling the gap? As a staunch free
market adherent those words make me cringe but I have to say them. For
animal welfare and biosecurity purposes we can't let large areas go
without some kind of veterinary presence.

The reason there are areas of Montana, and the rest
of the country, that lack a veterinary presence is because there's not
enough money in those areas to pay a vet, and not enough reason to go be
a vet there even if there were plenty of money. See above about
pulling calves in the 20 below dead of a Montana night.

Think that's cold? How 'bout 40 below? Because
Alaska is proposing a new program to produce 20 a year, in collaboration
with Colorado State. This article from a Fairbanks paper last year quotes
a Fairbanks veterinarian as saying the shortage of vets there leads to
burnout and high turnover. Typically, labor shortages lead to high
wages and lots of work which leads to happy veterinarians; it's crappy
working conditions and a lack of clients wiling to spend money that lead
to burnout and high turnover. Even if there were a shortage... does
Alaska need 20 more vets every year? Really? There's enough paying work
for TWENTY MORE VETS in Alaska every year, year after year?

And Utah is accepting it's first class of 30 this
fall, to spend their first two years in Logan and the last two in
Pullman at good ol' Washington State. Not to be a hater, but there's no
way Utah needs 30 more vets each and every single year. It's Utah.
I'm unaware of it being a huge agricultural power and a major
population center.

I haven't even mentioned the new schools that are
supposed to be starting in Arizona and Tennessee at over a hundred
students apiece every year. Or the bigger classes at lots of the
established schools...

So
I guess the takeaway for me is that it doesn't seem like the profession
is working as a system. The schools aren't hearing what we as
practitioners are saying. The VMAs certainly don't seem to be saying
much to the states. The AVMA can't figure out what it ought to be
saying.

I
hope things start getting better soon, but with the tsunami of new
grads hitting the market, and the livestock markets dropping like a rock
because of the drought, things are maybe going to get a lot worse
instead. I don't know what to do other than this. I'm scared for my
future.

Sincerely,

Dr. Who-the-hell-runs-this-joint-anyway-oh-*&^%-its-us

* Well, they will be slightly less heavily indebted.
Spending the first year at Bozeman instead of Pullman means $14,000
instead of $39,000, according to the colleges' websites. I grant that
$25,000 isn't chicken feed, but it's not exactly a huge reduction of the
$160,000 tab these kids are looking at running up before they graduate.
Well, more than that if you count inflation- Washington State's
tuition went up over 6% this past year. Plus there's interest while
you're in school now. Fabulous!

The AAEP is currently advising new grads who can't find jobs to start their own practices. That helps everything. I have three of 'em in two new practices right in my area, currently servicing the clients who don't pay and the crazies and the price shoppers. They've bled off just enough of my crazies and price shoppers that I've taken a part-time position outside vet medicine, which means I'm less available, which means clients complain there are no large animal veterinarians available. In fact, most of the large animal practices in my region have expanded the areas they're willing to cover, the result being that NO ONE is anywhere all the time, so clients complain they need more large animal veterinarians. I do not think this situation will improve anytime soon.

Has Montana done a supply and demand analysis to quantify the current losses they are experiencing due to the lack of access to veterinary services in large animal? Or the potential return on investment for both the state and the individual citizens who go through this program?

The article referred to states the program will consume about a half a million dollars a year.

The Governor is quoted as saying he expects strong cattle prices and high wheat yields to offset deficit spending in the 2013 budget. http://sunshinereview.org/index.php/Montana_state_budget

The drought would seem to have changed that: http://www.kfbb.com/news/local/Severe-Drought-Affecting-Montana-Farmers-and-Ranchers-170412966.html

Here's the Montana 2013 state budget summary. http://budget.mt.gov/content/execbudgets/2013_Budget/2013B_Yellow_Book.pdfAppropriations for Department of Livestock, Environment, Agriculture, Commerce, Labor and Industry are all down. Appropriations for Education are up 10%.

Looks to me like Montana is going to educate these kids right into indebted unemployment as large animal vets, forcing them into seeking work as small animal vets in the state's urban centers, or maybe other states... Meanwhile the areas that can't afford a vet for large animal remain unserved.

American medical schools are the same way. There is no "doctor shortage" like you hear the press and government screaming. There is a primary care shortage- we have plenty of docs, but the majority are specialists. So when you keep increasing class sizes all you do is increase the number of specialists out there down the road. Of course, the attempts to find a solution to the real issue: making people more interested in primary care - haven't come close to fixing it.

And, as a specialist, my decision to choose this path had nothing to do with money. It's because I genuinely like neurology (anyone who knows my personality will tell you I couldn't handle primary care). But I'm not sure how many people going into specialties these days are doing it for that reason.

Has anyone at VBB written a letter to the AVMA or some other organization addressing this fact? I think that someone who can actually do something about this trend needs to hear about it. I'm not entirely sure that the AVMA would be extremely helpful, but it's something.

Letters, phone calls, comments on news releases and blog posts... they're aware of the frustrations of front line veterinarians. Either they don't see the problem or they don't care. AVMA is part of Big Veterinary, interested in maintaining themselves as a dues-collecting body.

The veterinarian unemployment rate is 1.85%. I believe this statistic speaks loudly. There are 7 counties in California without a veterinarian. When a veterinarian finishes an outstanding internship like Animal Medical Center, it might take a few months longer but she can find a job in a highly sought after geographic location like San Diego. Things are changing and the old ways of assessing needs are not as meaningful.

The profession should look at the change that took place in dentistry. Fluoride eliminated more than half the cavities which were the mainstay of dental practice. They shifted to prevention and restoration.

There is an increase in pet obesity, diabetes, dental disease and ear issues that are going untreated.

Let's assume Dr. Newstudent graduates with $160,000 in loans. According to Mappingyourfuture.org, Dr. Newstudent will be paying $1841.28 monthly to support her loans, and will require a minimum annual salary of $276, 192. How many vets earn that type of salary? Dr. McClure, how many new grads are you, personally, willing to hire at that salary?

The USA has had, officially, over 40 months of unemployment over 8%. If labor force participation rate was the same as it was in 2009, the unemployment rate would be north of 11%. Real income for the middle class has been falling rather dramatically for 3 years. Quite frankly, our clients are struggling to afford our services as it is. If we raise our fees to cover quarter million dollar new grads, we probably won't have many clients left.

And now, even with the fierce struggle to stay in business, our profession seeks to increase the supply of vets? Basic econ tells us that increasing supply in a time of tenuous demand leads to lower prices for the commodity. How much more can we cut the prices to remain competitive?

Sadly, Dr. Newstudent is being set up for a fall. They are chasing the dream, just as we did. And she probably won't look at the financials, just like most of us (me included!) didn't. She will enter a profession that will have effectively ruled out being able to afford a home or children. Will she even be able to support herself with that debt burden? And no matter how much she loves the medicine, how long will she last in the profession? She will have sacrificed 6 years at least to the dream. Will she wait another 10 for her profession to start rewarding her for her sacrifice? Will she be happy waiting until her mid 30's, at minimum, to start her adult life?

Yes, we have a lot of things that go untreated. And there is a reason. Our clients have a hard time affording such treatments. Adding more vets will only make things worse for existing vets while brutally taking advantage of Dr. Newstudent and her peers.

Just did a little research into the job prospects for veterinarians in California. First I located those letters I've received from this June's veterinary school graduates just in the last month. They all seem well qualified, but they are still looking for a job. And I'm not hiring. I've been casually following the want ads in the Journal of the American Veterinary Medical Association for roughly the last 44 years. That's always been kinda fun even though I've not actually been looking for a new job since 1972. Used to be page after page after page of various opportunities. Have you looked at these ads lately, Dr. McClure? Let's just say that this section of the Journal has slimmed down more than I have. California job opportunities used to take up several pages. Now, it's a column and a half. And none of these ads sound desperate because they cannot find what they are looking for. Sadly, way too many of these few ads have been placed by that large corporate outfit that most call "The Borg", and otherwise known as the death rattle of our once fine profession. Ever see the movie "Open Range"? Remember the Pig Farm? That's where the old whores were forced to work when the finer houses could do better. These are the job prospects for too many new graduates today.

The Grey Man, I agree with the points you are making, but I find the figures you are putting out to be a little ludicrous. I realize that that is exactly what that website spits out, but payments of $1814/month only comes out to be $22k/year, so I'm not sure how they rationalize a salary of $276k. That is implying that even without the payments, the person should be making $254k/year, which is still an absurdly high salary for a starting veterinarian. Again, I agree with your premise, but the math is a bit unconvincing.

SalixAnthela, Your point about salary is duly noted. I do not claim to be a financial expert. No offense meant, but if I were, I wouldn't be replying to you. I'd be on my private island, enjoying something with a lot of rum in it.

Still that $1814/month is my house note, health insurance for me and The Bride (TM), and truck payment. Or a month's wages for an employee. It's a hell of a chunk of change for a new grad, and for a loooong time. And remember that that is after tax income they'll be losing.

Even if the numbers aren't exactly correct, we new grads do have a difficult time paying our loans. I have been practicing for only 2 years. I graduated with around $230k in student loans (I was an out of state student), and my payment right now is 1302/month. That is more than my house note and car payment combined. My husband and I are strict budgeters and we do still live like college students most of the time so that we can try to pay things off early. Even with all that I am only paying the interest on my loans right now and I don't see the light at the end of the tunnel

Which counties in California are without a veterinarian? Do those counties need a veterinarian? Are there populations of either pet owners or agricultural animals in those counties? If there are do those people have the money to pay a vet?

The change that took place in dentistry- you mean when a bunch of schools failed due to oversupply and the inability of graduate dentists to make a living?

I agree with the premise that we have 'put ourselves out of business' with the success of preventive care, to some degree. But I don't see a response form organized vet med like what dentistry seems to have- the national campaigns that educate consumers. We all know, thanks to very effective marketing by the ADA, that it is our responsibility to brush our teeth twice a day, go to the dentist twice a year and pay what they charge as a medical necessity. When we do go in, we all get free samples of the tools and supplies we need to do our part at home. Our kids all get free evaluations in school.

Where is the equivalent response from the members of the AVMA?

I agree there is lots of untreated obesity, dental disease and I would add arthritis and behavioural problems. I see it every shift I work. But I wonder if those conditions are going untreated because people won't pay to treat them.

That is exactly why they aren't being treated. I can't count the number of animals where I discuss addressing dental disease, arthritis and behavioral problems. I rarely have anyone who actually WANTS to do anything about it.

With all due respect, San Diego (and California, really) is one slice of the national pie. Where I live, the "position open" ads are even fewer and farther between than the one Bob describes; I've looked for said positions myself. I have a friend who, fresh off her internship at--you guessed it, AMC--can't find a GP job within 2 hours of a major metroplex surrounded by small towns and agriculture. The jobs picture is not good, and adding more graduates to the pool can only worsen it.

Allow me to mention something with regards to these so-called "numbers". Western in Pomona, CA is now charging those poor students some insane number for tuition - I don't have the exact figure, but it's at least $42,000 PER YEAR. So before living expenses, those students are gonna graduate with a minimum of $170,000 in tuition debt ALONE. AND WESTERN KEEPS RAISING IT ON THEM. Many are gonna have well over $200,000 in debt, go into a job starting at $60-$70K a year and then wake up and realize... I cannot make this payment OR if I make this payment I can never buy a house or raise a family because I am now a SLAVE TO THE DEBT. This is an outrage. So with all due respect, before I listen to anyone from Western tell me that the unemployment rate for vets is that low, perhaps the issue is not only whether they can FIND a job, but rather can they PAY for this ridiculous education?

Sitting on your high horse with your nice private job paid for by Banfield, while charging students a ridiculous amount of tuition for a PBL style of education is INSANE.

OK that was harsh, but an illustration of how insane this profession has become.

Here we are arguing about the shortage of vets in rural areas while the academia are telling us they can get jobs... in rich places like San Diego. Um, yeah.. hardly the rural area of Montana, now is it?

The profession IS in serious decline, because the standard of living in much of America is in decline. This is a fact. We are a reflection of what's happening to the country and it's showing up in the rural areas and the... uh, "less than rich" areas.

Live it up if you're in San Diego, though the ugly little truth is that you still won't be able to afford that $500,000 house in San Diego with that $125,000 salary because you already have a $2000 "house payment" disguised as student loan payment...

This isn't about finding jobs, you idiots. This is about finding JOBS THAT PROVIDE A STANDARD OF LIVING which is in severe decline within this profession.

And if you find a job that pays you enough, are you selling your soul for a boss that wants to reuse needles, syringes and paper towels?? Sorry, my first job might have paid the bills, but the boss was an asshole. And I hope that he meets a fire based end.... cheated clients, lied, had someone pretend to be me and cancelled my insurance. And he STILL provides no analgesia to patients during or after surgery.

And wasn't it a shock when I bought that same practice and learned that buying new needles, syringes and paper towels - not to mention updating equipment to the 21st century, stocking drugs to provide appropriate anesthesia and analgesia and on and on would eat up any possible profits. Also for the record, as it turns out, honesty isn't necessarily the best policy. I am ALWAYS honest with clients. But they still seem to prefer Dr. Old Guy who lied to them on a regular basis. It's a regular panacea out there.

I am furious that the AVMA gives out acreditatoin like mardi gras throws, but I have limited sympathy for the new grads from private and offshore schools who can't put 2&2 together and realize they are being had. I was well aware of starting salaries for the proffession before I entered undergrad and organized accordingly. I know new grads who have manageable debt (80k) so it can be done. Numerous classmates of mine established instate residency before applying since they were from non-SVM states and it was a good investment of time. Beyond future dilution of the applicant pool I worry about the number of starry-eyed idealists entering the profession who think that if the just chase their dreams hard enough everything will be ok somehow! Damn Barney selfactualized generation! I want rational colleagues who made a rational choice to be hear, no luneytoons who work three jobs and take 5 psych drugs to cope with the stress of having to actually have earnest economic discussions with clients.

I graduated over 10 years ago with average debt for new graduates at that time, have been paying those loans off ahead of schedule, and will be done in 3-4 years. Prior to veterinary school I was aware of salaries for large animal veterinarians not only for new graduates but for practice owners, and accordingly started my own practice a few years after graduation. You'd think everything would be just ducky.

Unfortunately, I had no control over the housing crash, the recession, and some events specific to my area that had an enormous impact on my practice, which was flying high as recently as 2007. As a result of the aforementioned, practices that had previously never entered my area in past years - not even to cover for me if I attempted to get away for a few days, mind you - are now actively soliciting clients in my area. Older practitioners came out of retirement when their investments tanked and reclaimed "their" clients. As I mentioned in my reply to Increasingly Calloused above, new graduates who can't find jobs simply open their own practices. Meanwhile, I've watched established practices in my area of all types go through bankruptcy. I guess I'm one of the lucky ones.

The problem with dismissing new grads as gullible, starry-eyed idealists is that the issues affecting employment of new graduates affect established, "rational" veterinarians with manageable debt, too. New graduates' distress is a symptom of the disease within veterinary medicine as a whole.

For the last few years I've been working part-time outside the profession because it's a stable paycheck and (gasp) I enjoy it. Taking a part-time job outside veterinary medicine is one of the best business decisions I've ever made. I'm far from "luneytoons" but yeah, it's also an improvement over having earnest discussions with clients who don't want to buy what I'm selling. For example, one of my colleagues called just last week to tell me one of his clients allowed a surgical colic to suffer for almost 24 hours before it died right before my colleague arrived at the farm. Why? Client had Banamine paste and figured the horse would survive until regular business hours so she wouldn't have to pay the after hours emergency fee. My colleague was greeted by a dead horse with a battered face and clients expecting comfort. Happy Monday.

Jenna I am totally with the over supply of vets and obviously the economy is screwed. The federal reserve and a parade of assclown politicians have held interest rates so low for a decade and a half that many people of all ilks who would be retired and living off the interest of their nest egg then passing the yolk of that egg to the kids are having to work since the Fed forced them to move that egg to the frying pan of the stock market. That delayed retirement prevents opportunity ect ect....... When I was a child we were always told that if we saved from the beginning of our careers our investments would grow but all mIne have done is shrink I figure I have to save $1.50 for every 1$ I want in retirement just to accomadate the bs. But I was not trying to address any of this just the notion that the people targeted by those nauseating Ross adds (the are you driven ones) are somehow victims. The solution for some more motivated than me is to find a way onto the AVMA accrediting committee with some like minded friends and make new guidelines banning schools w/o hospitals , 2+2 programs and enforcing faculty to student ratios that make class inflation an economically unatractive option. Those can all be rationally defended as being needed to ensure educational excellence I the ensuing anti-trust suit as appossed to naked protectionism via class size limitation . Ok there you go I gave you the answer now break huddle and infiltrate the AVMA acreditation board!

Oh and for the colicing horse that sucks but the great recession didn't invent those douchebags. Where I am I get the best of both worlds owners who won't treat and owners who won't stop treating long after sanity and hope of resolution have left the building . I just try to remember I make my living providing service not salvation.

I don't disagree with you at all, Lance, and to be honest I'm quite disappointed at the starry eyed applicants that I'm coming across nowadays. They don't listen. They want that DVM no matter the cost and don't care that those of us in the profession now are telling them they are crazy if they don't have the money in the bank to pay for this career without going into ridiculous debt for it, much less that is does suck ASS to be a vet nowadays. Good luck with your AVMA ideas, though, as I am one who feels it's a total lost cause. The AVMA is a political machine and I don't see it ever being effective or worth it. I stopped sending them money a long time ago!

Ha the AVMA plan is a gauntlet for others, I lack the motivation for that these day ( there are fish to catch ect.). I am fortunate to have a job I enjoy most shifts, but I fear for the direction the proffession is heading. The oversupply of vets is coming from both ends, old associate vets can't retire because 401k are in the trash, practice owners can't sell (economy sux and baby vets can't get a loan due to debt) so they are stuck in practice, and we have nearly doubled the number of accredited seats in our schools in a decade. We are going to see contraction of our wages for the foreseeable future. If I were a new grad with 200k of debt I would declare bankruptcy immediately and then go to nursing school.

The profession should look at the change that took place in dentistry. Fluoride eliminated more than half the cavities which were the mainstay of dental practice. They shifted to prevention and restoration. Glyn Willmoth

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